Level C

Level B

Level A

works closely with the core practice team to review prescribing practices and proactively assist patients with medication related problems such as non-adherence, side effects and medication management challenges.

What Do Your Choices Mean?

If you score in Level D in any area, your practice is just getting started and may want to review our resources page to help you prepare for the key changes described in that section of the guide.

If you score in Level C in any area, your practice is in the early stages of change and can benefit from the action steps and resources in that section of the guide.

If you score in Level B in any area, your practice has implemented basic changes and can build upon your success with the action steps and resources in that section of the guide.

If you scored in Level A in any area, your practice has achieved most or all of the important changes required. Congratulations! You can still use the actions steps and resources in that section of the guide to find new ways to improve.

Why is it important to rethink the role of the clinical pharmacist?

Clinical pharmacists have unique expertise in medication dosing, side effects, and efficacy. Conservative estimates of medication errors and adverse drug events in ambulatory care found an annual rate of more than half a million adverse drug events, with an annual cost of almost $900 million. Team-based care that includes a clinical pharmacist is one way to help prevent some of these adverse drug events. In addition, when clinical pharmacists are active members of the care team, they enhance efficiency by:

Providing critical input on medication use and dosing.

Working with patients to solve problems with their medications and improve adherence.

Consulting with primary care team members about medication-related issues.

Assisting with onboarding of new patients by reviewing medications and aligning treatment options to medication prescribing patterns of the new organization and primary care provider.

Reviewing and providing assistance with patients on multiple medications (polypharmacy) to help to simplify medication regimens.

Reviewing high-risk medication profiles, including review of patients on high-dose opioids or opioids with other high-risk medications (e.g., benzodiazepines)

Why Pharmacists Belong in the Medical Home

How should the role of the clinical pharmacist change?

Many clinical pharmacists are part of a centralized service that clinical staff can access for problematic patients or consult as needed. In contrast, clinical pharmacists at many LEAP sites actively work with patients as an integral part of the primary care team, doing tasks such as:

Participating in team huddles, panel management meetings, and other meetings that involve proactively addressing patient needs and/or problem-solving how best to meet the needs of high-risk patients.

Being available for warm handoffs.

Working with patients over time to problem solve medication issues and/or titrate medications.

Using motivational interviewing to address patients concerns or resistance to taking medications.

Conducting thorough medication reviews with patients.

Providing alternative visit care, such as teaming with PCP in group visits and addressing medication questions that are posed by patients via email or telephone inquiries.

What do we gain by making these changes?

When a clinical pharmacist is an integral member of the primary care team, they can help relieve provider workload, increase efficiency, and help care team members stay updated on best practices. They can also enhance the overall quality of care by working directly with patients to improve:

If your practice has a clinical pharmacist, assesswhether they are actively participating in team-based care and maximizing their role given scope of work guidelines and collaborative practice agreements in place.

View Resources

Role features

"Share the Care" Assessment of Team Roles and Tasks

This is an example of a planning tool, to assess who is currently doing what tasks in your practice and then who should be doing each task, based on how we learned that LEAP sites define clear roles and responsibilities. Task distribution will vary from practice to practice, but the tool is in the discussion about roles that this worksheet can stimulate. Your practice may be able to redestribute tasks in a way that better fits your workforce and patient needs.

Role of the Clinical Pharmacist

Learn how the Clinical Pharmacist is an integral part of the care team at one LEAP site, Union Square Family Health Center - Cambridge Health Alliance. The Clinical Pharmacist actively collaborates with patients and care team members, including medication review with patients, consultation with team members, planning visits, and participation in team huddles and panel management meetings. This video includes footage from the front lines, captured by LEAP site staff members themselves.

Create a job description that prioritizes integration with the primary care team and patient care. Communicate to care team members and patients about the services available from the clinical pharmacist. LEAP sites often optimize face-to-face interactions with care team members and patients, for example, by co-location of the clinical pharmacist in the team space.

View Resources

Role features

Clinical Pharmacist Job Description

Here is the job description of the pharmacist at HVMA, reflecting how the role is connected to the primary care team.

Patient Diabetes Education Materials - used by Pharmacist

Pharmacists can work with patients to help them manage their chronic conditions through self-management support. See how one LEAP site developed materials for a series of patient visits with the Pharmacist focused on health education and goal setting.

Provide your clinical pharmacist withtraining. In order to work effectively with patients, especially using motivational interviewing, pharmacists need related training.

View Resources

Staff training

Motivational Interviewing

This website offers various resources on motivational interviewing, maintained by the Motivational Interviewing Network of Trainers. Click on the link to see a list of upcoming in-person courses. There is also a link to online courses, when available.

Basic Skills and Clinical Applications of Motivational Interviewing

This online course is intended to train primary care practice staff seeking PCMH certification in the principals of motivational interviewing. It consists of two 30-minute modules on using MI to help patients change health behaviors, as well as providing scenarios in how the concepts can be used in the clinical setting. It is CME/CE certified, and is described on the site as a free service once site registration is completed.

Role featuresJob descriptions, career ladders and other HR materials

Role features

"Share the Care" Assessment of Team Roles and Tasks

This is an example of a planning tool, to assess who is currently doing what tasks in your practice and then who should be doing each task, based on how we learned that LEAP sites define clear roles and responsibilities. Task distribution will vary from practice to practice, but the tool is in the discussion about roles that this worksheet can stimulate. Your practice may be able to redestribute tasks in a way that better fits your workforce and patient needs.

Video

Video

Role of the Clinical Pharmacist

Learn how the Clinical Pharmacist is an integral part of the care team at one LEAP site, Union Square Family Health Center - Cambridge Health Alliance. The Clinical Pharmacist actively collaborates with patients and care team members, including medication review with patients, consultation with team members, planning visits, and participation in team huddles and panel management meetings. This video includes footage from the front lines, captured by LEAP site staff members themselves.

Patient materialsAction plans, brochures, team cards, welcome letters

Patient materials

Patient Diabetes Education Materials - used by Pharmacist

Pharmacists can work with patients to help them manage their chronic conditions through self-management support. See how one LEAP site developed materials for a series of patient visits with the Pharmacist focused on health education and goal setting.

Staff trainingTutorials, training manuals, etc.

Staff training

Motivational Interviewing

This website offers various resources on motivational interviewing, maintained by the Motivational Interviewing Network of Trainers. Click on the link to see a list of upcoming in-person courses. There is also a link to online courses, when available.

Basic Skills and Clinical Applications of Motivational Interviewing

This online course is intended to train primary care practice staff seeking PCMH certification in the principals of motivational interviewing. It consists of two 30-minute modules on using MI to help patients change health behaviors, as well as providing scenarios in how the concepts can be used in the clinical setting. It is CME/CE certified, and is described on the site as a free service once site registration is completed.

If you have a question about the improvements, action steps, or tools & resources in this module please let us know. We're here to help. And if we can't answer your question, we can probably connect you with someone who can.